Postnatal corticosteroids for the prevention of bronchopulmonary dysplasia

Bronchopulmonary dysplasia (BPD) remains a common complication of preterm birth with long term substantial consequences. The administration of postnatal corticosteroids in an attempt to attenuate the chronic lung injury is still a matter of ongoing debate after more than 30 years of research. Systematic reviews of the available randomised controlled trials (RCTs) have shown that administration of the main investigated corticosteroid, dexamethasone, is beneficial for short term pulmonary morbidity and mortality, but concerns about long term neurodevelopmental sequelae have resulted in recommendations of restricted use. Although these systematic reviews pool the results of the RCTs as they were homogeneous, they are hampered by clinical heterogeneity in terms of investigated cumulative dosage regimens. In this review, we will discuss the clinical consequences of the changes in prescribing postnatal steroids in this high risk population and provide new evidence on the modulating effects of the heterogeneity within the trials. Finally, we will discuss alternative strategies for the administration, the subtypes of postnatal corticosteroids and future research perspectives.